Suicidal behaviour is not lessened by higher treatment rate, study sho
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《英国医生杂志》
The number of people who attempted suicide or made suicidal "gestures" (cries for help rather than really wanting to kill themselves) and who received treatment rose significantly in the United States over a decade, a new study shows.
But although a greater proportion of people received treatment, over the same period there was no decline in the total number of people country-wide with suicidal behaviours, ranging from suicidal thoughts to suicide attempts. The findings seem to indicate that the increase in the treatment of emotional problems over the decade did not close the gap between disadvantaged groups and other people in the risk of suicidal behaviours.
The researchers, from Harvard Medical School, looked at the proportions of people among a nationally representative sample who reported suicidal behaviours in the previous 12 months and the proportion who reported receiving treatment for emotional problems in that period (JAMA 2005;293:2487-95). The data were based on the US national comorbidity survey, which was carried out in 1990-2 and repeated in 2001-3. Respondents who said that their suicide attempt was a "cry for help" but that they didn抰 intend to die were described as having made a suicidal gesture.
A total of 8098 people aged between 15 and 54 took part in the first survey (a response rate of more than 80%), and 9282 aged 18 or older took part in the second (around 70%).
No significant differences between the first and the second survey were found in the prevalence of suicidal ideation (2.8% v 3.3% of participants; χ2=0.6, P=0.44), suicide plans (0.7% v 1%; χ2=2.1, P=0.15), suicidal gestures (0.3% v 0.2%; χ2=1.4, P=0.24), or suicide attempts (0.4% v 0.6%, χ2=0.6, P=0.44).
But between the two surveys there was a significant increase in the proportion of participants with suicidal thoughts who made a suicide plan (19.6% v 28.6%; χ2=4.4, P=0.04) and a fall in the proportion of people who made a suicide plan who also made a gesture (21.4% v 6.4%; χ2 =10.0, P=0.002).
The treatment rate rose sharply among those participants with suicidal thoughts who made a gesture (40.3% v 92.8%; χ2=5.6) and among those who attempted suicide (49.6% v 79%; χ2=2.4).
"We found that risk of suicide-related behaviors is consistently elevated in several vulnerable sub-groups, including the young, women, individuals with low education, and those lacking stable relationships and employment," the authors wrote. "Substantial barriers to uptake of effective interventions continue to exist, including competing clinical demands and distorted incentives for treating mental disorders and symptoms," wrote the authors. They add that failure to widely disseminate evidence based treatments may help explain why suicidality did not decline in response to the increase in treatment during the 1990s.
Meanwhile, new data presented last week at a meeting of the American Psychiatric Association show that the antipsychotic drug quetiapine (Seroquel) reduced the prevalence of suicidal thoughts in patients with bipolar depression and that it also improved quality of life and adherence to treatment.
The data come from an eight week, multicentre, randomised controlled trial involving 542 patients with a diagnosis of bipolar I or II disorder. Seroquel was found to be around twice as effective as placebo at reducing suicidal ideation by the eighth week of the study.(Quebec David Spurgeon)
But although a greater proportion of people received treatment, over the same period there was no decline in the total number of people country-wide with suicidal behaviours, ranging from suicidal thoughts to suicide attempts. The findings seem to indicate that the increase in the treatment of emotional problems over the decade did not close the gap between disadvantaged groups and other people in the risk of suicidal behaviours.
The researchers, from Harvard Medical School, looked at the proportions of people among a nationally representative sample who reported suicidal behaviours in the previous 12 months and the proportion who reported receiving treatment for emotional problems in that period (JAMA 2005;293:2487-95). The data were based on the US national comorbidity survey, which was carried out in 1990-2 and repeated in 2001-3. Respondents who said that their suicide attempt was a "cry for help" but that they didn抰 intend to die were described as having made a suicidal gesture.
A total of 8098 people aged between 15 and 54 took part in the first survey (a response rate of more than 80%), and 9282 aged 18 or older took part in the second (around 70%).
No significant differences between the first and the second survey were found in the prevalence of suicidal ideation (2.8% v 3.3% of participants; χ2=0.6, P=0.44), suicide plans (0.7% v 1%; χ2=2.1, P=0.15), suicidal gestures (0.3% v 0.2%; χ2=1.4, P=0.24), or suicide attempts (0.4% v 0.6%, χ2=0.6, P=0.44).
But between the two surveys there was a significant increase in the proportion of participants with suicidal thoughts who made a suicide plan (19.6% v 28.6%; χ2=4.4, P=0.04) and a fall in the proportion of people who made a suicide plan who also made a gesture (21.4% v 6.4%; χ2 =10.0, P=0.002).
The treatment rate rose sharply among those participants with suicidal thoughts who made a gesture (40.3% v 92.8%; χ2=5.6) and among those who attempted suicide (49.6% v 79%; χ2=2.4).
"We found that risk of suicide-related behaviors is consistently elevated in several vulnerable sub-groups, including the young, women, individuals with low education, and those lacking stable relationships and employment," the authors wrote. "Substantial barriers to uptake of effective interventions continue to exist, including competing clinical demands and distorted incentives for treating mental disorders and symptoms," wrote the authors. They add that failure to widely disseminate evidence based treatments may help explain why suicidality did not decline in response to the increase in treatment during the 1990s.
Meanwhile, new data presented last week at a meeting of the American Psychiatric Association show that the antipsychotic drug quetiapine (Seroquel) reduced the prevalence of suicidal thoughts in patients with bipolar depression and that it also improved quality of life and adherence to treatment.
The data come from an eight week, multicentre, randomised controlled trial involving 542 patients with a diagnosis of bipolar I or II disorder. Seroquel was found to be around twice as effective as placebo at reducing suicidal ideation by the eighth week of the study.(Quebec David Spurgeon)